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Conditions: Peyronies Disease

Peyronie’s Disease and Erectile Dysfunction

Peyronie’s Disease and Erectile DysfunctionPeyronie’s disease (PD), a condition marked by plaques that form just below the skin of the penis, can affect men in different ways. The most notable symptom is curvature of the penis, but men may also have pain or penile shortening. Psychological and emotional issues are also common, especially if the man is unable to have intercourse.

Erectile dysfunction (ED) is another common problem for men with PD. Studies have shown that between 22% to 54% of men with PD also have problems getting an erection firm enough for sex. (The wide range is due to the variety of ED definitions and criteria used by researchers.)

Unfortunately, scientists aren’t sure why so many men with PD also have ED. It’s also difficult to assess given the many factors that affect erectile function, such as aging and comorbid conditions like diabetes and heart disease.


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Conditions: Peyronies Disease

Traction Therapy for Peyronie’s Disease

Do you work with men who have Peyronie’s disease? If so, they might be considering non-surgical treatment options. One is traction therapy and a recent Journal of Sexual Medicine study has shown some encouraging results.

Peyronie’s Disease – Some Basics

First, however, let’s go over some basics about Peyronie’s disease. It’s thought to stem from a penile injury that does not heal properly. Such an injury could happen during sports or vigorous intercourse, but sometimes, a man doesn’t even know that he has injured his penis.

For men with Peyronie’s disease, areas of hardened scar tissue called plaques form below the skin’s surface. These plaques cause the penis to lose some of its flexibility and bend.

Peyronie’s disease occurs in two stages. In the acute phase (the first 6 to 18 months), the plaques form and the penis curves. Many men experience pain, erectile dysfunction (ED), and penile shortening. Intercourse may become difficult.

In the chronic stage, the disease becomes more stable. Usually, the curve doesn’t worsen, but men still can still have problems with ED and intercourse.

Significant emotional distress can also occur during each stage.

Treatment for Peyronie’s disease depends on its severity. For some men, the situation resolves on its own or the curve is not bothersome. For others, the curve is so severe that they cannot have intercourse at all. These men may consider surgical treatment once the disease reaches the chronic stage.

What is Traction Therapy?

Men who undergo traction therapy for Peyronie’s disease wear a medical device specifically designed to gently pull the penis in the opposite direction of the curve.

A recent study by Spanish researchers found that this technique had good results for men in the acute stage of Peyronie’s disease.

Fifty-five patients (mean age 50) underwent traction therapy using the Andropeyronie device, a commonly used brand. A control group of 41 patients (mean age 48) had no intervention. All of the men had acute-state Peyronie’s disease.

The men receiving traction therapy were instructed to wear the device for at least six hours a day, but no longer than nine hours. Patients were also told to remove the device for at least 30 minutes every two hours to avoid glans ischemia. This group also had penile sonography to evaluate the status of their plaques.

After six months of treatment, the men in the traction therapy group saw a number of improvements:

·         Mean penile curvature at erection was reduced from 33 degrees at baseline to 15 degrees.

·         Mean penile length increased from 12.4 centimeters at baseline to 13.7 centimeters.

·         The men reported less pain and improved erectile function and hardness.

·         More men were able to penetrate a partner.

·         Sonographic plaques disappeared in 48% of the patients.

·         The need for surgery was reduced in 40% of the patients. Among the men who did need surgery, about one third were able to have simpler procedures.

·         These results were maintained at a 9-month follow-up point.

In contrast, the men who received no intervention did not fare so well:

·         After six months, their mean degree of curvature increased from 29 degrees at baseline to 51 degrees after six months.

·         Mean penile length decreased from 14.5 centimeters at baseline to 12.1 centimeters.

·         They reported more pain and poorer erectile function and hardness.

·         Fewer men were able to penetrate a partner.

·         After nine months, there were no significant improvements.

Compliance with treatment was an important factor for the traction therapy group. The men wore the device for a mean of 4.6 hours a day. However, those who wore it for more than six hours a day generally had better results.

Overall, the researchers concluded that penile traction therapy “seems an effective treatment” for men in the acute stage of Peyronie’s disease, as pain, curvature, and sexual function improved in their study group.

Is penile traction therapy right for your patients? It could be, especially if they are motivated to wear the device for the recommended amount of time. However, only a urologist can answer this question for certain. Clinicians are encouraged to refer their patients with Peyronie’s disease to the appropriate specialists.

Print this article or view it as a PDF file here: Traction Therapy for Peyronie’s Disease


Andromedical Corp./Andropeyronie

“FAQ – Method and Instructions”

The Journal of Sexual Medicine

Martínez-Salamanca, Juan I., MD, PhD, et al.

“Acute Phase Peyronie's Disease Management with Traction Device: A Nonrandomized Prospective Controlled Trial with Ultrasound Correlation”
(Full-text. First published online: November 22, 2013)

Sexual Medicine Society of North America

“Peyronie’s Disease”

Urology Care Foundation

“Peyronie’s Disease”

(Last updated: March 2013)

Conditions: Peyronies Disease

FDA approves first drug treatment for Peyronie’s disease


For Immediate Release: Dec. 6, 2013
Media Inquiries: Andrea Fischer, 301-796-0393,
Consumer Inquiries: 888-INFO-FDA

The U.S. Food and Drug Administration today approved a new use for Xiaflex (collagenase clostridium histolyticum) as the first FDA-approved medicine to treat men with bothersome curvature of the penis, a condition known as Peyronie’s disease.

Xiaflex is the first FDA-approved non-surgical treatment option for men with this condition, who have a plaque (lump) in the penis that results in a curvature deformity of at least 30 degrees upon erection.

Peyronie’s disease is caused by scar tissue that develops under the skin of the penis. This scar tissue causes an abnormal bend during erection and can cause problems such as bothersome symptoms during intercourse.

“Today’s approval expands the available treatment options for men experiencing Peyronie’s disease, and enables them, in consultation with their doctor, to choose the most appropriate treatment option,” said Audrey Gassman, M.D., deputy director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research.

Xiaflex is a biologic medicine (made from the protein product of a living organism, collagenase clostridial histolyticum). Xiaflex was first approved by the FDA in 2010 for the treatment of Dupuytren’s contracture, a progressive hand disease that can affect a person’s ability to straighten and properly use their fingers. Xiaflex is believed to work for Peyronie’s disease by breaking down the buildup of collagen (a structural protein in connective tissue) that causes the curvature deformity.

A treatment course for Peyronie’s disease consists of a maximum of four treatment cycles. Each treatment cycle consists of two Xiaflex injection procedures (in which Xiaflex is injected directly into the collagen-containing structure of the penis) and one penile modeling procedure performed by the health care professional.

The safety and effectiveness of Xiaflex for the treatment of Peyronie’s disease were established in two randomized double-blind, placebo-controlled studies in 832 men with Peyronie’s disease with penile curvature deformity of at least 30 degrees. Participants were given up to four treatment cycles of Xiaflex or placebo and were then followed 52 weeks. Xiaflex treatment significantly reduced penile curvature deformity and related bothersome effects compared with placebo.

When prescribed for the treatment of Peyronie’s disease, Xiaflex is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) because of the risks of serious adverse reactions, including penile fracture (rupture of one of the penile bodies within the penile shaft, also known as corporal rupture) and other serious penile injury. Xiaflex for the treatment of Peyronie’s disease should be administered by a health care professional who is experienced in the treatment of male urological diseases. The REMS requires participating health care professionals to be certified within the program by enrolling and completing training in the administration of Xiaflex treatment for Peyronie’s disease. The REMS also requires health care facilities to be certified within the program and ensure that Xiaflex is dispensed only for use by certified health care professionals.

The most common adverse reactions associated with use of Xiaflex for Peyronie’s disease include penile hematoma, penile swelling and penile pain.

Consumers and health care professionals are encouraged to report adverse reactions from the use of Xiaflex to the FDA’s MedWatch Adverse Event Reporting program at or by calling 1-800-FDA-1088.

Xiaflex is marketed by Auxilium Pharmaceuticals, Inc., based in Chesterbrook, Pa.

Click here to read the press release on the FDA's site.

Conditions: Peyronies Disease

Peyronie’s Disease – Talking to a Healthcare Provider

It’s important for men with Peyronie’s disease – and their partners - to know that they’re not alone. Many men are embarrassed about their condition or feel nervous about discussing it with a doctor. But having the discussion an important step in learning how to manage the condition. Here, we’ll discuss how common Peyronie’s disease is, offer reasons and tips for talking to the doctor, suggest other ways to find support, and give a brief look at current research, treatment, and prognosis.

How common is Peyronie’s disease?

Peyronie’s disease is more common than one may think. In fact, published medical studies show that between 3% and 9% of men have Peyronie’s disease. However, the Association for Peyronie’s Disease Advocates (APDA) believes the rate is higher, since not all cases are diagnosed.

Peyronie’s disease can affect any man at any age, but most men with the condition are middle aged. Men with a family history of Peyronie’s disease or Dupuytren’s contracture, a connective tissue disorder of the hand, tend to be at higher risk. Some scientists believe that diabetes, high blood pressure, and smoking raises the likelihood that a man will develop Peyronie’s disease. Invasive surgery, like removal of the prostate, may increase the risk as well.

Talking to the Doctor

Peyronie’s disease is treated by urologists - doctors who specialize in problems with the penis and related organs. But not all urologists are experienced in treating Peyronie’s disease. A man should feel comfortable with his urologist and confident that the physician has the necessary expertise. If there are any doubts, men should get a second opinion or change to a new urologist.

Sometimes, making that first appointment is the hardest step. A man with Peyronie’s disease may feel ashamed to admit he has a problem, especially with a part of his body that defines his masculinity. He may also feel nervous about treatment.


But taking that step has a number of benefits:

  • Reassurance. A urologist experienced with Peyronie’s disease can put a man at ease, giving him the facts about the condition and what can be done about it. Having a specific action plan can make a man feel more in control of the situation.
  • Referrals for counseling and sex therapy. Peyronie’s disease can take an emotional toll on men and their partners. Men may feel depressed because they can’t have sex the way they used to. They may feel anxious about future sexual activity. Both patients and their partners may start to withdraw from each other and communicate less. An experienced doctor can refer men and their partners to counseling, which can help resolve these issues. A sex therapist can also help the couple communicate about sex and suggest strategies for improving intimacy in the relationship.
  • Individual guidance. A man’s urologist knows his specific situation and can answer questions on a more personal basis.
  • Support. A urologist can recommend reliable books, articles, and websites with more information on Peyronie’s disease for men and their partners. They may also suggest support groups or online support communities where men and their partners can talk with others in similar situations.


Men planning their first appointment are encouraged to write down the details of their symptoms and any questions they may have. It’s also common to bring photographs of the erect penis taken from different angles. This helps the doctor see exactly what kind of curve and plaque formation are taking place. Sometimes partners need to take these pictures.

Some men choose to bring their partners to their appointments. Partners can provide support and be a “second set of ears” when the doctor explains the condition and treatment. Partners may also think of questions that haven’t occurred to the patient.

Finding Support

Men with Peyronie’s disease don’t have to face the condition alone. It may help to talk to others who are having similar problems and emotions. Some men choose to join support groups suggested by their urologist.

Online support communities are another option. In fact, some men prefer online communities because they can remain anonymous and feel more comfortable expressing themselves. One such online community can be found on the Association for Peyronie’s Disease Advocates website. (Click here for the direct link.)

Men with Peyronie’s disease can discuss the problem man-to-man, using their own language to share their concerns, suggest alternative ways to be intimate, help each other with relationship issues and depression, and offer coping strategies. Partners can also benefit from support networks, sharing their perspectives with patients and other partners.

Support doesn’t need to come from others with Peyronie’s disease, however. Trusted friends and relatives can also provide excellent support, if a man is comfortable talking with them.  

Current Research

Scientists are investigating different options for men with Peyronie’s disease through clinical trials. For example, Auxilium Pharmaceuticals has been testing a drug called Xiaflex, which is injected into the penis. Xiaflex has been approved by the FDA to treat Dupuytren’s contracture, a hand condition that produces areas of hardened scar tissue similar to the plaques of Peyronie’s disease. Researchers hope that the drug will break down plaques on the penis much like it breaks down collagen for people with Dupuytren’s contracture.

Other researchers are examining whether testosterone pellets plus vitamins D and E will help men with Peyronie’s disease. Injections of botulinum toxin type A, commonly known as Botox®, are also being studied.

Men who wish to participate in a clinical trial should talk to their doctor.

Treatment and Prognosis

There are several different treatments available for Peyronie’s disease. A man’s doctor can help him decide which treatment option is best for him.

Men with Peyronie’s disease can have a good prognosis for sexual function, especially if treatment begins within 6 months after symptoms begin. For many men, the pain and plaque formation eventually subside and they can still enjoy intimacy with their partner.


Association of Peyronie’s Disease Advocates

“Doctor Discussion Guide”

“How common is Peyronie’s disease?”

“Working with Your Doctor”

“H-22411: BOTOX® for Peyronie's Disease”

(Last updated: October 24, 2012)

“Testosterone Pellets Plus Vitamin D and E Versus Vitamin D and E Alone for the Treatment of Peyronie's Disease (PD+)”

(Last updated: December 17, 2012)


Sexual Medicine Society of North America

“What is the Curve? Understanding the Emotional Impact of Peyronie’s Disease”

“Xiaflex Trials Show Promise for Peyronie’s Treatment”

(July 30, 2012)


University of Miami Leonard M. Miller School of Medicine - Department of Urology

“Peyronie’s Disease”



“Erectile Dysfunction: Peyronie’s Disease”

(Reviewed: February 23, 2011)

Conditions: Peyronies Disease

What is the Curve? The Emotional Impact of Peyronie’s Disease

Peyronie’s disease isn’t talked about much and many men with a curved penis or a bent penis don’t realize that their condition has a name. But Peyronie’s disease happens to about 3% to 9% of men, according to published research. The Association of Peyronie’s Disease Advocates (APDA) suggests that this rate might be even higher because of undiagnosed cases.

Peyronie’s disease is a wound-healing disorder, meaning an injury to the penis hasn’t healed properly. This injury could be from something major, like a car accident, or something more common, like a sports injury or vigorous sex.


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Conditions: Peyronies Disease

Treating Peyronie’s Disease

Pills for PD

Researchers have studied a number of oral therapies for PD, including: carnitine, colchicine, potassium aminobenzoate, tamoxifen, and vitamin E, the first oral therapy used for PD was believed to be of value because of its antioxidant properties. The other oral agents were studied because they are thought to have properties that interfere with collagen synthesis and scar formation.

Unfortunately, most studies using oral PD therapies haven’t been well controlled. Since some PD cases improve on their own and few studies of oral medication have compared treated patients to an untreated “control group,” it’s not clear that the oral therapies for PD offer any benefit over no treatment at all in terms of penile curvature, pain, or the ability to have intercourse. The active phase of Peyronie’s disease takes 12 to 18 months. After this pain generally goes away but most patients are left with a penile nodule/plaque. The Peyronie’s plaque causes bending and shortening of the erection.

Intralesional injection therapy

Several agents have been studied as intralesional injection therapies, meaning that they’re injected directly into the PD plaques, or lesions. Some of the earliest drugs used in this way were steroids. Currently, intralesional steroid injection is discouraged in the treatment of PD because there are no clear benefits, it can cause penile tissue to atrophy, or waste away, and it can complicate subsequent surgery.

Verapamil, a calcium channel blocker usually used to treat high blood pressure, has been shown to stop collagen synthesis and increase collagenase activity, thereby promoting scar remodeling.

Likewise, interferon injections have been associated with PD improvement. In placebo-controlled studies, documented benefits have been established. Interferons work by increasing collagenase and reducing collagen formation.

Topical gel therapy

Verapamil was introduced as a topical gel in the mid 1990s. It was hoped that the drug, which had been somewhat successful as an intralesional injection, could produce the same results with less discomfort in this noninvasive form. Unfortunately, when applied topically, the drug fails to reach the tunica albuginea. This was confirmed when men scheduled to undergo penile prosthesis surgery had verapamil gel applied to the penile shaft the night before and morning of surgery. During surgery, small tissue samples from each man’s tunica albuginea were removed and examined for verapamil. No verapamil was detected in any of the sampled tissue.


The process of iontophoresis, also known as electromotive drug administration or EMDA, uses an electric current to administer a drug through intact skin. In the treatment of PD, this technique has been used to administer vera-dexamethasone—through a fluid-filled reservoir affixed to the penile skin overlying the plaque sites. Early investigation found the treatment effective in reducing pain, plaque size, and penile curvature. Furthermore, measurable levels of verapamil have been found in tunica albuginea samples taken from men undergoing surgery for penile straightening and plaque removal.

Electroshock wave therapy

Electroshock wave therapy has been tested as a means of breaking up PD plaques, promoting plaque resorption, improving blood flow to the penis, and straightening the penis. To date, no consistent improvements in penile curvature, plaque size, sexual function, or rigidity have been reported with this treatment.


Men who have had PD for more than one year, are unable to have satisfactory sexual intercourse, and whose PD is painless and stable may be candidates for PD surgery (see “Is PD Surgery Right for You?” on page 10). Surgery is still the “gold standard” for correcting penile curvature associated with PD, and surgical technique has improved tremendously over the past several years.

No one type of surgery is right for all patients. If you can maintain a satisfactory erection (with or without medication), the curve in your penis is less than 60 degrees, and your penis has neither an hourglass nor a hinge deformity, your doctor may recommend tunica albuginea plication. When plication is performed, the tissue of the tunica albuginea on the opposite side of the plaque is plicated, or stitched, to counteract the bending effect.

If your penis has more severe curvature, or if there is severe narrowing in your penile shaft so that it cannot become erect without buckling, then a more complex surgery is required: plaque incision and grafting. This requires the plaque to be incised (cut into), straightened, and filled in with a graft, which is either composed of living tissue from another part of your body or harvested from human or animal tissue.

If post-surgical erections are unsatisfactory, treatment with Cialis, Levitra, or Viagra may be prescribed to enhance erectile response.

Prosthetic surgery (a penile implant) was once the mainstay of PD therapy. Today, that type of surgery is performed only on patients with PD and ED. Plaque excision (removal) is reserved for men with severe calcified PD.

All PD surgeries carry potential risks, including incomplete straightening, ED, and diminished penile sensation. Before undergoing any type of PD surgery, be sure to discuss all risks thoroughly with your doctor.

In most cases, surgical correction of PD successfully straightens the penis and makes it more rigid, but in the early phases of PD, other approaches are usually tried first. If you have signs and symptoms of PD, talk to your doctor about what treatment is best for you.

Conditions: Peyronies Disease

Diagnosing Peyronie’s Disease

The plaques of PD develop in the tunica albuginea—the fibrous tissue that covers the penile erection chambers, known as the corpus cavernosa. The plaques restrict penile expansion during erection and cause the erect penis to bend in the direction of the plaques, which are usually on the upper (or “dorsal”) surface but may be on the underside (the “ventral” surface) or on either side (“lateral” plaques). Some plaques are so small that they cause only a slight indentation. Others go all the way around the penis, causing the penis to take on an hourglass shape. Generally, the greater the curvature of the penis, the more difficult it is to penetrate during sexual intercourse. Hourglass and indentation deformities can cause sexual difficulty too, sometimes causing the penis to buckle during penetration attempts.

Peyronie’s disease may be associated with pain, especially in the initial stages, and with penile shortening. Many men with PD have erectile dysfunction (ED), which means they find it difficult to have an erection or to maintain one long enough to have satisfactory sex.
Contrary to popular belief, in most cases, PD does not get better without treatment. Spontaneous improvement or resolution has been said to occur in anywhere from 3% to 15% of all cases.

How common is PD and who gets it?

In the late 1990s, PD was thought to be relatively uncommon, with many researchers reporting a prevalence of only 1%. Recent studies, however, suggest that the condition is far more widespread. A 2004 survey of 534 men undergoing urologic examination at prostate cancer screening centers revealed that nearly 9% had signs of PD.
Typically, PD is diagnosed in middle-aged men, though it can occur in men of any age, from adolescence onward. Although it tends to occur most frequently in Caucasians, men of any ethnic group may develop PD.

Conditions: Peyronies Disease

Overview - Peyronie’s Disease

In Peyronie's Disease, hard nodules, called plaques, form in the sheath surrounding the vascular erectile tissue within the penile shaft. The plaques, which are not cancerous, cause the penis to bend toward the affected side. This can interfere with erection and penetration and reduce penile length, causing much distress for the man and his partner.

The causes of PD are not altogether clear. Fortunately, however, as research into the disease continues, new medical therapies are emerging and surgical techniques are being refined.

In this article, we’ll discuss what is known about PD—possible causes, typical signs and symptoms, frequency, and risk. We’ll explore some of the myths surrounding the disease, describe the treatments currently in use or under investigation, and discuss which patients are most likely to benefit from the various treatments.

Print this article or view it as a PDF file here: Overview - Peyronie's Disease

Conditions: Peyronies Disease

Causes - Peyronie’s Disease


Much is still unknown about the causes of PD, but research suggests it is a disorder of wound healing. The PD plaques are actually hardened scar tissue. It’s widely believed that the disease is triggered by an injury to the erect penis—often one that goes unnoticed by the man. What is unclear is why a relatively minor injury would lead to such excessive scarring.
Normally, wounds heal in three phases: First, enzymes clean the wound of dead or damaged tissue. Second, the body repairs the wound by forming a scar that strengthens the injured tissue. Finally, the collagen fibers that make up the scar are broken down and realigned leaving a smaller “remodeled” scar. In PD, not only is scar formation extreme, but scar remodeling either fails to occur or is insufficient.
The abnormal scarring of PD is believed to be related to the actions of fibrin and cytokines, which stimulate the formation of scar tissue in the second phase of wound healing. It seems that, in PD, these substances allow excessive amounts of collagen to collect. The enzymes protease and collagenase, which are responsible for remodeling scar tissue in the third phase of wound healing, also may play a role. Patients with PD may produce too few of these enzymes or the enzymes they produce may not function properly to remodel the scar.
Some investigators believe that the tendency to develop PD may be inherited. There is a reported association between PD and a genetic disorder called Dupuytren’s contracture, in which scar tissue forms along the sheath surrounding tendons in the palm of the hand, causing the ring finger to contract inward.

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